Method and system for predictive physiological gating

ABSTRACT

A method and system for physiological gating is disclosed. A method and system for detecting and predictably estimating regular cycles of physiological activity or movements is disclosed. Another disclosed aspect of the invention is directed to predictive actuation of gating system components. Yet another disclosed aspect of the invention is directed to physiological gating of radiation treatment based upon the phase of the physiological activity. Gating can be performed, either prospectively or retrospectively, to any type of procedure, including radiation therapy or imaging, or other types of medical devices and procedures such as PET, MRI, SPECT, and CT scans.

CROSS-REFERENCE TO RELATED APPLICATION

The present invention claims priority to U.S. application Ser. No.09/178,383 filed Oct. 23, 1998, Ser. No. 09/178,385 filed Oct. 23, 1998,Ser. No. 09/712,724 filed Nov. 14, 2000, which is a continuation of Ser.No. 09/178,384 filed Oct. 23, 1998, which are hereby incorporated byreference in their entirety.

BACKGROUND AND SUMMARY

The present invention relates to medical methods and systems. Moreparticularly, the invention relates to a method and system forphysiological gating.

Many types of medical procedures involve devices and machines that actupon a particular portion of a patient body. For example, radiationtherapy involves medical procedures that selectively expose certainareas of a human body, such as cancerous tumors, to high doses ofradiation. The intent of the radiation therapy is to irradiate thetargeted biological tissue such that the harmful tissue is destroyed. Incertain types of radiotherapy, the irradiation volume can be restrictedto the size and shape of the tumor or targeted tissue region to avoidinflicting unnecessary radiation damage to healthy tissue. Conformaltherapy is a radiotherapy technique that is often employed to optimizedose distribution by conforming the treatment volume more closely to thetargeted tumor.

Other medical procedures are also directed to specific portions of apatient body. For example, radiation imaging typically directs radiationonly to the portion of a patient body to be imaged. 3-dimensionalimaging applications such as computed topography (CT), PET, and MRIscans also are directed to specific portions of a patient body.

Normal physiological movement represents a limitation in the clinicalplanning and delivery of medical procedures to a patient body. Normalphysiological movement, such as respiration or heart movement, can causea positional movement of the body portion undergoing treatment,measurement, or imaging. With respect to radiation therapy, if theradiation beam has been shaped to conform the treatment volume to theexact dimensions of a tumor, then movement of that tumor duringtreatment could result in the radiation beam not being sufficientlysized or shaped to fully cover the targeted tumoral tissue. For imagingapplications, normal physiological movement could result in blurredimages or image artifacts.

One approach to this problem involves physiological gating of themedical procedure, such as gating of a radiation beam during treatment,with the gating signal synchronized to the movement of the patient'sbody. In this approach, instruments are utilized to measure thephysiological state and/or movement of the patient. Respiration has beenshown to cause movements in the position of a lung tumor in a patient'sbody; if radiotherapy is being applied to the lung tumor, then atemperature sensor, strain gauge, preumotactrograph, or optical imagingsystem can be utilized to measure the patient during a respirationcycle. These instruments can produce a signal indicative of the movementof the patient during the respiratory cycle. The radiation beam can begated based upon certain threshold amplitude levels of the measuredrespiratory signal, such that the radiation beam is disengaged orstopped during particular time points in the respiration signal thatcorrespond to excessive movement of the lung tumor.

Many approaches to physiological gating are reactive, that is, theseapproaches utilize gating methods that slavishly react to measuredlevels of physiological movements. One drawback to reactive gatingsystems is that the measured physiological movement may involve motionthat that is relatively fast when compared to reaction time of theimaging or therapy device that is being gated. Thus, a purely reactivegating system may not be able to react fast enough to effectively gatethe applied radiation. For example, the gating system may include aswitch or trigger for gating radiation which requires a given timeperiod Δt to fully activate. If the delay period Δt is relatively longcompared to the measured physiological motion cycle, then a systememploying such a trigger in a reactive manner may not be able toeffectively gate the radiation at appropriate time points to minimizethe effect of motion.

Therefore, there is a need for a system and method to address these andother problems of the related art. There is a need for a method andsystem for physiological gating which is not purely reactive to measurephysiological movement signals.

The present invention provides an improved method and system forphysiological gating. According to one embodiment, gating is performedbased upon visual detection of patient motion relating to physiologicalactivity. In an embodiment, an optical-based system is employed tomeasure and record physiological patient movement, in which a cameratracks and views the movement of a marker block or marker(s). A methodand system is also disclosed for detecting and predictably estimatingregular cycles of physiological activity or movements. Another aspect ofan embodiment of the invention is directed to predictive actuation ofgating system components. Yet another aspect of the invention isdirected to physiological gating based upon the phase or non-periodicityof the physiological activity. The present invention can also be used togate, either prospectively or retrospectively, any type of procedure,including radiation therapy or imaging, other types of medical devicesand procedures such as MRI, PET, SPECT, and CT scans.

An embodiment of the invention also provides a system and method forposition and motion monitoring including prompting the patient to holdbreath and monitoring of the breath-hold state of the patient. In oneembodiment, a patient positioning system comprises at least one camera,a marker block, and a computing device to compute the location andorientation of the marker block. The marker block preferably comprises aplurality of landmarks, e.g., retro-reflective markers. According to anembodiment, a method for identifying the position of a patient comprisesthe steps of first co-locating the marker block with a patient, viewingthe marker block with at least one camera, producing image coordinatesfor the identified landmarks viewed by the camera, comparing the imagecoordinates with reference coordinates for the landmarks, and thereafterdetermining the position and orientation of the patient.

Consistent patient positioning, either within the same device fordifferent sessions, or between multiple devices, is facilitated using anoptical-based positioning system, according to one embodiment of thepresent invention. Within the same device, the positioning systemprovides absolute position information for the patient that can bere-created during each treatment session. Between multiple devices, theoptical-based positioning system establishes relative positioninginformation for the patient. The relative positioning information can beused to correctly conform the position of the patient between multipledevices. In one embodiment, a patient undergoes treatment planning at afirst device during which an optical positioning system identifies afirst relative position for the patient. Thereafter, the patient iscontrollably positioned to a therapy device, e.g., using a movabletreatment table or in which the patient remains stationary but eitherthe treatment planning or therapy device are moved in relation to thepatient, e.g., on rails. The relative position of the patient to thetherapy device is established and manipulated to conform to the desiredtreatment strategy.

The present invention also provides a novel method and mechanism forimplementing a physiological monitor, such as a respiration monitor. Inone embodiment, a physiological monitor is implemented using anoptical-based system in which a video camera records body movementrelating to the physiological activity being monitored. The image datarelating to the body movement is processed and displayed to representthe physiological movement. The movement data can be analyzed and viewedto monitor the physiological activity.

User interface inventions are disclosed for controlling and displayingmotion, positioning, and gating information. In one embodiment, acircular interface is provides to control gating or treatment intervalsbased upon phase of physiological movement. Interface embodiments of theinvention provide display and control for enabling/disabling gating andestablishing gating thresholds. Additional interface embodiments displaybreath hold parameters and physiological motion range information.

One embodiment of the invention provides a method and mechanism forvideo and/or audio prompting of patients to maintain desiredphysiological movement patterns. A disclosed embodiment employs a sliderimage that simultaneously displays visual feedback of the physiologicalmovement as well as a desired range of the movement. For respirationactivity, the slider comprises a movable slider bar that moves inresponse to a patient's inhale-exhale movements. This provides visualprompting and feedback regarding the respiration activity. In anembodiment, verbal prompting are employed to assist in controlling,maintaining, or manipulating the physiological activity of interest. Forrespiration activity, such verbal promptings could be computer-activatedprompting to instruct a patient to breath in and breath out.

These and other aspects, objects, and advantages of the invention aredescribed below in the detailed description, drawings, and claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings are included to provide a furtherunderstanding of the invention and, together with the DetailedDescription, serve to explain the principles of the invention.

FIG. 1 depicts the components of a system for physiological gatingaccording to an embodiment of the invention.

FIG. 2 depicts an example of a respiratory motion signal chart.

FIG. 3 depicts a motion signal chart and a gating signal chart.

FIG. 4 is a flowchart showing process actions performed in an embodimentof the invention.

FIG. 5 is a flowchart showing process actions for detecting andpredicting regular physiological movements.

FIG. 6 a depicts a side view an embodiment of a camera and illuminatorthat can be utilized in the invention.

FIG. 6 b depicts a front view of the camera of FIG. 6 a.

FIG. 7 a depicts a retro-reflective marker according to an embodiment ofthe invention.

FIG. 7 b depicts a cross-sectional view of the retro-reflective markerof FIG. 7 a.

FIG. 8 depicts an apparatus for making a retro-reflective marker.

FIG. 9 depicts a phase chart synchronized with a gating signal chart.

FIG. 10 depicts an embodiment of a hemispherical marker block.

FIG. 11 depicts an embodiment of a cylindrical marker block.

FIG. 12 a depicts a system for physiological gating according to anembodiment of the invention.

FIG. 12 b illustrates an interface for viewing, controlling, and/orplanning a gating plan.

FIG. 13 a shows a flowchart of a process for detecting periodicity orlack of periodicity according to an embodiment of the invention.

FIG. 13 b illustrates sample trains according to an embodiment of theinvention.

FIG. 13 c is an example chart of showing phase and amplitude for aperiodic signal.

FIG. 13 d shows an example of a periodic signal amplitude-phasehistogram chart.

FIGS. 14 a,14 b, and 14 c depict embodiments of a marker block.

FIG. 15 shows a flowchart of a process for estimating position andorientation of a marker block according to an embodiment of theinvention.

FIGS. 16 and 17 show embodiments of slider interfaces according toembodiments of the invention.

FIG. 18 shows a system for positioning a patient among multiple devicesaccording to an embodiment of the invention.

FIG. 19 is a diagram of a computer hardware system with which thepresent invention can be implemented.

FIGS. 20-24 show interfaces for controlling, displaying, and planningaccording to embodiments of the invention.

DETAILED DESCRIPTION

An aspect of an embodiment of the present invention comprises a methodfor detecting and predictively estimating regular cycles ofphysiological activity or movement. Also disclosed are embodiments ofsystems and devices for patient positioning, positioning monitoring,motion monitoring, and physiological gating of medical procedures suchas imaging and radiation therapy. The systems and methods of theinvention can be employed for any regular physiological activity,including for example, the respiratory or cardiac cycles, and formonitoring temporary breath-hold state of the patient.

System for Patient Position Monitoring and Physiological Gating

FIG. 1 depicts the components of an embodiment of a system 100 forphysiological gating, position monitoring, and motion monitoring, inwhich data representative of physiological activity is collected with anoptical imaging apparatus. For the purposes of illustration, system 100is particularly described with reference to physiological gating ofradiation therapy. Thus, system 100 comprises a radiation beam source102 such as a conventional linear accelerator which is positionallyconfigured to direct a radiation beam at a patient 106 located ontreatment table 104. It is noted, however, that system 100 can also beapplied to gate other medical procedures, such as gating for CT imagingapplications or non-radioactive imaging applications such as MRI.

In system 100 for physiological gating, a switch 116 is operativelycoupled to the radiation beam source 102. Switch 116 can be operated tosuspend the application of the radiation beam at patient 106. In anembodiment, switch 116 is part of the mechanical and electricalstructure of radiation beam source 102. Alternatively, switch 116comprises an external apparatus that is connected to the controlelectronics of radiation beam source 102. Switch 116 may also comprise asoftware-based control mechanism.

An optical or video image apparatus, such as video camera 108, is aimedsuch that at least part of the patient 106 is within the camera's fieldof view. Camera 108 monitors patient 106 for motion relating to theparticular physiological activity being measured. By way of example, ifrespiration movements of the patient are being monitored, then camera108 is configured to monitor the motion of the patient's chest.According to an embodiment, camera 108 is placed on the ceiling, wall,or other support structure with its axis tilted down between 20 and 70degrees relative to the horizontal longitudinal axis of the patient 106.For measurement of respiration motion, the video image field of view ispreferably set to view an approximately 30 cm by 30 cm area of thepatient's chest. For purposes of illustration only, a single camera 108is shown in FIG. 1. However, the number of cameras 108 employed in thepresent invention can exceed that number, and the exact number to beused in the invention depends upon the particular application to whichit is directed.

In an embodiment, one illumination source per camera (which is aninfrared source in the preferred embodiment) projects light at thepatient 106 on treatment table 104. The generated light is reflectedfrom one or more landmarks on the patient's body. The camera 108, whichis directed at patient 106, captures and detects the reflected lightfrom the one or more landmarks. The landmarks are selected based uponthe physiological activity being studied. For respiration measurements,the landmarks are preferably located on one or more locations on thepatient's chest.

The output signals of camera 108 are sent to a computer 110 or othertype of processing unit having the capability to receive video images.According to a particular embodiment, computer 110 comprises an IntelPentium-based processor running Microsoft Windows NT or 2000 andincludes a video frame grabber card having a separate channel for eachvideo source utilized in the system. The images recorded by camera 108are sent to computer 110 for processing. If camera 108 produces ananalog output, the frame grabber converts the camera signals to adigital signal prior to processing by computer 110. Based upon the videosignals received by computer 110, control signals can be sent fromcomputer 110 to operate switch 116.

According to one embodiment, one or more passive markers 114 are locatedon the patient in the area to be detected for movement. Each marker 114preferably comprises a reflective or retro-reflective material that canreflect light, whether in the visible or invisible wavelengths. If theillumination source is co-located with camera 108, then marker 114preferably comprises a retro-reflective material that reflects lightmostly in the direction of the illumination source. Alternatively, eachmarker 114 comprises its own light source. The marker 114 is used inplace of or in conjunction with physical landmarks on the patient's bodythat is imaged by the camera 108 to detect patient movement. Markers 114are preferably used instead of body landmarks because such markers 114can be detected and tracked more accurately via the video imagegenerated by camera 108. Because of the reflective or retro-reflectivequalities of the preferred markers 114, the markers 114 inherentlyprovide greater contrast in a video image to a light detecting apparatussuch as camera 108, particularly when the camera 108 and illuminationsource are co-located.

Utilizing a video or optical based system to track patient movementprovides several advantages. First, a video or optical based systemprovides a reliable mechanism for repeating measurement results betweenuses on a given patient. Second, the method of the invention isnoninvasive, and even if markers are used, no cables or connections mustbe made to the patient. Moreover, if the use of markers is impractical,the system can still be utilized without markers by performingmeasurements of physiological activity keyed to selected body landmarks.Finally, the method of the invention is more accurate because it isbased upon absolute measurement of external anatomical physicalmovement. The present patient monitoring system is particularly suitableto track motion and position of patients for which intrusive/cumbersomeequipment cannot or should not be used. For example, the presentoptical-based system is suitable for monitoring the movement andposition of infants.

A possible inefficiency in tracking the markers 114 is that the markermay appear anywhere on the video frame, and all of the image elements ofthe video frame may have to be examined to determine the location of themarker 114. Thus, in an embodiment, the initial determination oflocations for the marker 114 involves an examination of all of the imageelements in the video frame. If the video frame comprise 640 by 480image elements, then all 307200 (640*480) image elements are initiallyexamined to find the location of the markers 114.

For real-time tracking of the marker 114, examining every image elementfor every video frame to determine the location of the marker 114 inreal-time could consume a significant amount of system resources. Thus,in an embodiment, the real-time tracking of marker 114 can befacilitated by processing a small region of the video frame, referred toherein as a “tracking gate”, that is placed based on estimation of thelocation of the already-identified marker 114 in a previous video frame.The previously determined location of a marker 114 defined in theprevious video frame is used to define an initial search range (i.e.,the tracking gate) for that same marker in real-time. The tracking gateis a relatively small portion of the video frame that, in oneembodiment, is centered at the previous location of the marker 114. Thetracking gate is expanded only if the tracking algorithm can not locatethe marker 114 within the gate. As an example, consider the situationwhen the previously determined location of a particular marker is imageelement (50,50) in a video frame. If the tracking gate is limited to a50 by 50 area of the video frame, then the tracking gate for thisexample would comprise the image elements bound within the area definedby the coordinates (25,25), (25,75), (75,25), and (75,75). The otherportions of the video frame are searched only if the marker 106 is notfound within this tracking gate.

The video image signals sent from camera 108 to computer 110 are used togenerate and track motion signals representative of the movement ofmarker 114 and/or landmark structures on the patient's body. FIG. 2depicts an example of a motion signal chart 200 for respiratory movementthat contains information regarding the movement of marker 114 during agiven measurement period. The horizontal axis represents points in timeand the vertical axis represents the relative location or movement ofthe marker 114. According to an embodiment, the illustrated signal inFIG. 2 comprises a plurality of discrete data points plotted along themotion signal chart 200.

FIGS. 6 a and 6 b depict an embodiment of a camera 108 that can used inthe present invention to optically or visually collect datarepresentative of physiological movement. Camera 108 is a charge-coupledevice (“CCD”) camera having one or more photoelectric cathodes and oneor more CCD devices. A CCD device is a semiconductor device that canstore charge in local areas, and upon appropriate control signals,transfers that charge to a readout point. When light photons from thescene to be imaged are focussed on the photoelectric cathodes, electronsare liberated in proportion to light intensity received at the camera.The electrons are captured in charge buckets located within the CCDdevice. The distribution of captured electrons in the charge bucketsrepresents the image received at the camera. The CCD transfers theseelectrons to an analog-to-digital converter. The output of theanalog-to-digital converter is sent to computer 410 to process the videoimage and to calculate the positions of the retro-reflective markers406. According to an embodiment of the invention, camera 108 is amonochrome CCD camera having RS-170 output and 640×480 pixel resolution.Alternatively, camera 408 can comprise a CCD camera having CCIR outputand 756×567 pixel resolution.

In a particular embodiment of the invention, an infra-red illuminator602 (“IR illuminator”) is co-located with camera 108. IR illuminator 602produces one or more beams of infrared light that is directed in thesame direction as camera 108. IR illuminator 602 comprises a surfacethat is ringed around the lens 606 of camera body 608. The surface of IRilluminator 602 contains a plurality of individual LED elements 604 forproducing infrared light. The LED elements 604 are organized as one ormore circular or spiral patterns on the IR illuminator 602 surroundingthe camera lens 606. Infrared filters that may be part of the camera 108are removed or disabled to increase the camera's sensitivity to infraredlight.

According to an embodiment, digital video recordings of the patient in asession can be recorded via camera 108. The same camera 108 used fortracking patient movement can be used to record video images of thepatient for future reference. A normal ambient light image sequence ofthe patient can be obtained in synchronization with the measuredmovement signals of markers 114.

FIGS. 7 a and 7 b depict an embodiment of a retro-reflective marker 700that can be employed within the present invention. Retro-reflectivemarker 700 comprises a raised reflective surface 702 for reflectinglight. Raised reflective surface 702 comprises a semi-spherical shapesuch that light can be reflected regardless of the input angle of thelight source. A flat surface 704 surrounds the raised reflective surface702. The underside of flat surface 704 provides a mounting area toattach retro-reflective marker 700 to particular locations on apatient's body. According to an embodiment, retro-reflective marker 700is comprised of a retro-reflective material 3M#7610WS available from 3MCorporation. In an embodiment, marker 700 has a diameter ofapproximately 0.5 cm and a height of the highest point of raisedreflective surface 702 of approximately 0.1 cm. Alternatively, a markercan comprise a circular, spherical, or cylindrical shape.

FIG. 8 depicts an apparatus 802 that can be employed to manufactureretro-reflective markers 700. Apparatus 802 comprises a base portion 804having an elastic ring 806 affixed thereto. Elastic ring 806 is attachedto bottom mold piece 808 having a bulge protruding from its center. Acontrol lever 810 can be operated to move top portion 812 along supportrods 814. Top portion 812 comprises a spring-loaded top mold piece 814.Top mold piece 814 is formed with a semi-spherical cavity on itsunderside. In operation, a piece of retro-reflective material is placedon bottom mold piece 808. Control lever 810 is operated to move topportion 812 towards base portion 804. The retro-reflective material iscompressed and shaped between the bottom mold piece 808 and the top moldpiece 814. The top mold piece 814 forms the upper exterior of theretro-reflective material into a semi-spherical shape.

In an alternate embodiment, marker 114 comprises a marker block havingone or more reference locations on its surface. Each reference locationon the marker block preferably comprises a retro-reflective orreflective material that is detectable by an optical imaging apparatus,such as camera 108.

According to one embodiment of the invention, physiological gating isperformed by sensing physiological motion, e.g., respiration motion,using video tracking of retro-reflective markers attached to a markerblock. One embodiment of the marker block 1471 utilizes two markers 1473and 1475 on a rigid hollow and light plastic block 1477 measuring about6 Cm×4 Cm×4 Cm as shown in FIG. 14 c. The two markers 1473 and 1475 arepreferably placed at a fixed distance of three centimeter on the side ofthe block that will face the tracking camera. The fixed distance betweenthe two markers 1473 and 1475 is known and is used to calibrate themotion of the block in the direction of the line connecting the twomarkers.

According to one embodiment, the pixel coordinates of each marker in thevideo frame are tracked. The distance in the pixel domain between thetwo markers for each video frame is thereafter measured. The knownphysical distance of the two markers is divided by the measured distanceto provide the scale factor for transforming the incremental motion ofthe block in the direction of the line connecting the two markers. Thisscale factor is updated for each new video frame and transforms theincremental motion of each marker from pixel domain to the physicaldomain. The transformation accounts for changes in the camera viewingangle, marker block orientation, and its distance to the camera duringmotion tracking.

FIG. 11 depicts alternate embodiment of a marker block 1100 having acylindrical shape with multiple reference locations comprised ofretro-reflective elements 1102 located on its surface. Marker block 1100can be formed as a rigid block (e.g., from plastic). Blocks made in thisfashion can be reused a plurality of times, even with multiple patients,e.g., if the normal hospital anti-infection procedures are followed. Theretro-reflective elements 1102 can be formed from the same material usedto construct retro-reflective markers 114 of FIGS. 7 a and 7 b. Themarker block is preferably formed from a material that is light-weightenough not to interfere with normal breathing by the patient.

A marker block can be formed into any shape or size, as long as thesize, spacing, and positioning of the reference locations are configuredsuch that a camera or other optical imaging apparatus can view andgenerate an image that accurately shows the positioning of the markerblock. For example, FIG. 10 depicts an alternate marker block 1000having a hemispherical shape comprised of a plurality ofretro-reflective elements 1002 attached to its surface.

The marker block can be formed with shapes to fit particular body parts.For example, molds or casts that match to specific locations on the bodycan be employed as marker blocks. Marker blocks shaped to fit certainareas of the body facilitate the repeatable placement of the markerblocks at particular locations on the patient. Alternatively, the markerblocks can be formed to fit certain fixtures that are attached to apatient's body. For example, a marker block can be formed withinindentations and grooves that allow it to be attached to eyeglasses. Inyet another embodiment, the fixtures are formed with integral markerblock(s) having reflective or retro-reflective markers on them.

An alternate embodiment of the marker block comprises only a singlereference location/reflective element on its surface. This embodiment ofthe marker block is used in place of the retro-reflective marker 406 todetect particular locations on a patient's body with an optical imagingapparatus.

FIGS. 14 a and 14 b depict other embodiments of marker blocks 1402 and1406 usable in the invention. Marker block 1402 includes a rectangularshape having multiple reflective or retro-reflective marker elements1404 located on it. Marker block 1402 supports a rigidly mounted set ofmarkers 14504 spread over an approximate volume of 1.5″×3″×4″. Themarkers should appear as high contrast features in a real-time imagingdevice such as a video camera whose images are digitized and processedby a computer system. This realization of the marker block employsretro-reflective material covering a set of 0.25-inch diameter spheresglued or otherwise attached to a rigid plastic box or platform. Markerblock 1406 includes a non-rectangular structure having multiplereflective or retro-reflective marker elements 1408 located on it. In anembodiment, the marker block is attached to the patient using standardhospital adhesive tape. In applications for which patient position andmotion is monitored in multiple patient visits within a common set ofreference coordinates, the marker block is preferably positioned foreach visit at the same location, e.g., using two or more indelible markson the patient skin.

Patient position and motion can be monitored by optical tracking of amarker block, such as a marker block 1402 or 1406, attached to a patientchest, abdomen, back, or other suitable patient location. In operation,a camera or video view of the marker block produces a set of imagecoordinates for the marker elements on the marker block. The positionand distance of any marker element located on the marker block is knownrelative to other marker elements on the same marker block. By comparingthe position and distance between the marker elements on a recordedimage frame with the reference position and image stored for themonitoring system, the absolute position and orientation of the markerblock can be estimated with a high degree of accuracy. This, in turn,provides an accurate position and orientation estimation for the patientor patient body position upon which the marker block is attached. Notethat estimation of patient position and orientation can be performed inthe invention using only a single marker block, rather requiring theplacement of multiple markers on different parts of a patient's skin.Moreover, a single camera can be used to track the position of themarker block, rather than requiring triangulation using multiple camerasfrom different positions.

FIG. 15 depicts a flowchart of a process for tracking a marker block(e.g., marker blocks shown in FIG. 14 a or 14 b) using a single cameraaccording to an embodiment of the invention. At step 1502, thecoordinates of the markers on the marker block are accurately surveyedin a coordinate system affixed to the marker block. This survey data isstored as reference data, and provides the known relative positioningand distances between markers on the marker block. At step 1504, thegeometric calibration model of the overall imaging chain is obtained andstored. The parameters of this model relate the position of a point in3-dimensional reference coordinates of the room or treatment area wherethe patient is located to the 2-dimensional image coordinates of thecorresponding pixel in the digital image. This calibration model forboth steps 1502 and 1504 can be derived offline, e.g., after the camerais mounted rigidly in the room, and is preferably repeated occasionallyas a check.

At step 1506, a new image frame is digitized from the camera videostream. At step 1508, an estimated position and orientation for themarker block is determined. The position and orientation of the markerblock can be quantified in six degrees of freedom (DOF), e.g.,x-coordinate, y-coordinate, z-coordinate, pitch, yaw, and roll. Thisestimated position and orientation is preferably using the samecoordinate system affixed to the marker block and used for the survey ofstep 1502. This initial six DOF can be the approximate known markerblock position and orientation, e.g., from the latest successfulestimation of the marker block six DOF in a previous image frame in thevideo stream.

At step 1509, the estimated marker block six DOF, the geometriccalibration model from step 1504, and the marker survey data from step1502 are used to mathematically project the center of each marker andobtain an estimated pixel coordinates of each marker in the image frame.

At step 1510, the digitized image frame from step 1506 is analyzed todetect and locate the markers in pixel coordinates. If the previoustracking was successful, use the projected centers of step 1509 to limitthe search area for each marker to increase the computationalefficiency. If processing the first image frame, or recovering from losttrack, then the whole frame is analyzed to find and locate markers. Ifthree or more markers are found by the image analysis process, thenproceed to Step 1512; otherwise, the process returns back to Step 1506for a new image frame in the input video stream. In an embodiment of theinvention, a subset of three or more markers should be visible to ensurea proper calculation of the six DOF coordinates for the marker block.However, this subset can vary from frame to frame in the input videostream.

At step 1512, the mathematically projected pixel coordinates arecompared with the actual marker pixel coordinates. If the difference,e.g., measured in mean of squared distances in pixel domain, is below athreshold then the marker block six DOF (from step 1508) is accepted asthe final estimate of the marker block for the current image frame. Theprocess then returns to step 1506 for the next image frame in the videostream.

If the difference between the mathematically projected pixel coordinatesand the actual marker pixel coordinates exceed a defined threshold, thenthe procedure proceeds to step 1516 to estimate a new six DOF for themarker block. The new six DOF for the marker block is estimated basedupon incremental changes to the assumed marker block six DOF that wouldresult in a closer match between the mathematically projected points andthe marker coordinates found in the actual digitized image. One approachfor this estimation uses the Gauss method based on computing the inverseJacobian matrix of pixel positions as a function of the six DOFparameters. The process uses this incremented marker block six DOF asthe new assumed six DOF for the marker block and iterates by loopingback to step 1512.

While the process of FIG. 15 is usable with only a single camera,multiple cameras can also be used to expand the viewing volume of thepatient monitoring system, or to allow continued operation of the systemwhen the view of one camera is obstructed. When multiple cameras areused, the above process can be employed for each camera, independently,or triangulation of image data can alternatively be used to providecoordinates for the marker block.

The output of the process of FIG. 15 comprises position and orientationdata for the marker block that can be correlated to the position andorientation of a patient to which it is attached. Analysis ofsimultaneously recorded internal image data, e.g., fluoroscopic video,can also be used to confirm correlation of these externally attachedmarkers with internal organ motion. Tracking of the marker block allowsmonitoring of the patient motion in diagnostic and therapy imagingapplications where image data acquisition is gated or synchronized withperiodic motion. It can also be used to monitor position in imaging ortherapy machine coordinates for procedures that use the breath-holdmethod. As described in more detail below, the amplitude and/or phase ofthe marker block coordinates vs. time, corresponding to the motion andphase of patient physiological activity, can be used to trigger imageacquisition or non-acquisition at specific points during normal periodiccycle (e.g., breathing cycle) to minimize image distortion effects ofpatient motion. The amplitude and/or phase can also be used to triggertreatment or non-treatment at specific points during the normal periodicmovements.

The marker block position can also be treated as a signal that isprocessed to detect deviations from periodic breathing such as thosecaused by coughing. This condition is used to stop image acquisition ordelivery of radiation therapy to minimize the effects of unplannedmotion.

In addition, the instantaneous marker block position can be used as arespiration monitor signal. Rather than requiring cumbersome orintrusive devices to monitor respiration of a patient, the videoapproach of this embodiment of the invention provides a non-intrusivemechanism to monitor patient respiration. The measured movement of themarker block can be used as an indicator of patient respiration. Thus,quantifiable values such as amplitude and/or phase of the marker blockmovement can be generated to monitor patient respiration. These valuescan be displayed and analyzed for breathing patterns using anyconventional respiration analysis algorithms.

Physiological Gating

The following description of physiological gating applies to controllingradiation in radiation therapy/imaging and to controlling the imageacquisition process in imaging applications. Furthermore, the techniquesare applicable to the breath-hold method of therapy and imaging as wellas gating in normal periodic breathing mode. For radiation procedures,e.g., X-ray radiotherapy and CT imaging, gating is performed bysynchronizing the application of radiation to physiological activitysuch as patient motion. In emission imaging methods such as PET and MRI,the acquisition of data can be synchronized with patient motion so thatthe data corresponding to a specific position or state of the patient is“binned” separately to minimize the effect of motion.

To perform physiological gating according to an embodiment of theinvention, one or more sets of data representative of the physiologicalactivity of interest are collected for the patient in an embodiment ofthe invention. An optical-based system, such as system 100 of FIG. 1using marker(s) or a marker block, may be employed to generate data forphysiological activity usable in the invention.

One aspect of physiological gating is the determination of theboundaries of the treatment interval or interval range for applyingradiation or gating data acquisition. For gating purposes, thresholdpoints can be defined over the amplitude range of the motion signal todetermine the boundaries of the treatment intervals. Motion of theexternal marker(s) that falls outside the boundaries of the treatmentintervals correspond to movement that is predicted to cause unacceptablelevels of movement. The external marker(s) motion is therefore acceptedas a surrogate for the motion of internal anatomy and is thus used tocontrol the imaging or therapy process. According to an embodiment, thetreatment intervals correspond to the portion of the physiological cyclein which motion of the clinical target volume is minimized. Otherfactors for determining the boundaries of the treatment intervalsinclude identifying the portion of the motion signals involving theleast movement of the target volume or the portion of the motion signalinvolving the largest separation of the target volume from organs atrisk. Thus, the radiation beam pattern can be shaped with the minimumpossible margin to account for patient movement.

To illustrate with respect to radiation therapy, radiation is applied tothe patient only when the motion signal is within the designatedtreatment intervals. Referring to FIG. 3, depicted are examples oftreatment intervals, indicated by signal range 302, which has beendefined over the motion data shown in motion signal chart 200. In theexample of FIG. 3, any movement of the measured body location thatexceeds the value of 0.4 (shown by upper boundary line 304) or whichmoves below the value of 0.0 (shown by lower boundary line 306) fallsoutside the boundaries of the treatment intervals.

Shown in FIG. 3 is an example of a gating signal chart 300 that isaligned with motion signal chart 200. Any motion signal that fallsoutside the treatment interval signal range 302 results in a “beam hold”gating signal threshold 310 that stops the application of radiation tothe patient. Any motion signal that is within the treatment intervalsignal range 302 results in a “beam on” gating signal threshold 312 thatallows radiation to be applied to the patient. In an embodiment, digitalsignals that represent the information shown in motion signal chart 200are processed by computer 110 and compared to the threshold levels ofthe treatment interval signal range 302 to generate gating signalthresholds 310 and 312. Alternatively, gating signal thresholds 310 and312 can be obtained by feeding analog motion signals to a comparator tobe compared with analog threshold signals that correspond to treatmentinterval signal range 302. In any case, gating signal thresholds 310 and312 are generated by computer 110 and are applied to the switch 116 thatcontrols the operation of radiation beam source 102 (FIG. 1) to stop orstart the application of a radiation beam at patient 106.

FIG. 4 is a flowchart of the process actions performed in an embodimentof the invention. The first process action is to define boundaries forthe treatment intervals over the range of motion signals to be detectedby a camera (402). As indicated above, any motion that fall outside theboundaries of the treatment intervals correspond to motion that ispredicted to result in unacceptable levels of movement of the tumor ortissue targeted for irradiation. An optical or video imaging system,such as a video camera, is used to measure the physiological motion ofthe patient (404), and the output signals of the optical or videoimaging system are processed to compare the measured motion signals withthe threshold boundaries of the treatment intervals (406).

If the motion signal is outside the boundaries of the treatmentintervals, then a “beam off” gating signal threshold is applied to aswitch that is operatively coupled to the radiation beam source (408).If the radiation beam source is presently irradiating the patient (410),then the switch setting is operated to hold or stop the radiation beam(411). The process then returns back to process action 406.

If the motion signal is within the boundaries of the treatmentintervals, then a “beam on” gating signal threshold is produced (412)and is applied to a switch that is operatively coupled to the radiationbeam source. If the radiation beam source is presently not being appliedto the patient (413), then the switch setting is operated to turn on orapply the radiation beam source to irradiate the patient (414). Theprocess then returns back to process action 406.

According to one embodiment, the radiation beam source can be disengagedif a significant deviation is detected in the regular physiologicalmovements of the patient. Such deviations can result from suddenmovement or coughing by the patient. The position and/or orientation ofthe targeted tissue may unacceptably shift as a result of thisdeviation, even though the amplitude range of the motion signal stillfalls within the boundaries of the treatment intervals during thisdeviation. Thus, detection of such deviations helps define theappropriate time periods to gate the radiation treatment.

The present invention can be applied to perform physiological gating ofother medical procedures that are affected by patient movement, inaddition to radiation therapy. For example, imaging procedures, such asCT, PET, and MRI scans, are subject to a range of image errors due topatient movement, including blurring, smearing, and the appearance ofimage artifacts. One or more treatment intervals or range intervals,e.g., as shown in FIG. 3, are established over the imaging cycle to gatethe collection of image data from the patient. The treatment intervalsdefine boundaries of physiological movement that is predicted toincrease the likelihood of image errors. Motion within the boundaries ofthe treatment interval is predicted to correspond to fewer image errors.The treatment intervals are used to gate the application of radiation oracquisition of images from the patient using an imaging device. Forexample, during the “beam hold” portion of the treatment interval, theapplication of radiation for a CT system can be suspended. During the“beam on” portion of the treatment interval, radiation is applied to thepatient from the CT system to generate image data. Alternatively, gatingcan be performed by merely suspending the collection of data, eventhough the imaging device is still activated. For example, the CT systemmay still apply radiation to the patient through its entire cycle, butphysiological gating is performed to suspend the recordation of dataduring the gating periods.

In 3-dimensional imaging applications such as CT, PET and MRI, thesignal representing physiologically activity can also be used toretrospectively “gate” the reconstruction process. For this purpose, theacquisition of raw transmission or emission data is synchronized to acommon time base with the physiological signal. Segments of the acquiredraw data that correspond to movement cycle intervals of interest areused to reconstruct the volumetric image thus minimizing the distortionand size changes caused by patient motion.

One embodiment of the present invention provides a method for detectingand predictively estimating a period of a physiological activity. Ineffect, the present invention can “phase lock” to the physiologicalmovement of the patient. Since the gating system phase locks to themovement period, deviations from that periodic signal can be identifiedand appropriately addressed. For example, when gating to the respiratorycycle, sudden movement or coughing by the patient can result indeviation from the detected period of the respiration cycle. If theinvention is employed in a radiation therapy system, radiation treatmentcan be gated during these deviations from the regular period.Identifying these deviations from periodicity can also be used to gateother types of medical procedures, such as imaging application. Thepresent invention also provides a method for predictively estimating theperiod of the subsequent physiological movement to follow.

FIG. 5 is a process flowchart of an embodiment of the invention toperform predictive estimation and detection of regular physiologicalmovement cycles. In process action 502, an instrument or system (such assystem 100 from FIG. 1) is employed to generate data signalsrepresentative of the physiological activity of interest. In anembodiment, the data signals comprises a stream of digital data samplesthat collectively form a signal wave pattern representative of thephysiological movement under examination. A number of discretemeasurement samples are taken for the physiological activity during agiven time period. For example, in an embodiment of the inventiondirected towards respiratory measurement, approximately 200-210 datasamples are measured for each approximately 7 second time interval.

In process action 504, pattern matching analysis is performed againstthe measured data samples. In an embodiment, the most recent set of datasamples for the physiological signal is correlated against animmediately preceding set of data samples to determine the period andrepetitiveness of the signal. An autocorrelation function can beemployed to perform this pattern matching. For each new sample point ofthe physiological motion or physiological monitoring sensor signal, theprocess computes the autocorrelation function of the last n samples ofthe signal, where n corresponds to approximately 1.5 to 2 signalbreathing periods. The secondary peak of the autocorrelation function isthen identified to determine the period and repetitiveness of thesignal.

In an alternate embodiment, an absolute difference function is usedinstead of an autocorrelation function. Instead of secondary peak, asecondary minimum in the absolute difference is searched for. For eachnew sample point of the physiological motion or physiological monitoringsensor signal, the process computes the minimum absolute differencebetween the two sets of data over a range of overlapping data samples.The secondary minimum corresponds to the data position that best matchesthe recent set of data samples with the preceding set of data samples.

Yet another alternate embodiment performs a pattern matching based upona model of the physiological activity being measured. The model is adynamic representation of the physiological motion or physiologicalmonitoring sensor signal for that physiological activity. The latest setof data samples is matched against the model to estimate parameters ofthe repetitive process.

Pattern matching using the measured physiological signal (504) providesinformation regarding the degree of match, as well as a location of bestmatch for the repetitive process. If an autocorrelation function isemployed in process action 504, then the relative strength of secondarypeak provides a measure of how repetitive the signal is. A thresholdrange value is defined to provide indication of the degree of matchbetween the two sets of data samples. If the strength of the secondarypeak is within the defined threshold range (process action 508), thenthe degree of match indicates that the signal is repetitive, and thesecondary peak location provides an estimate of the signal period. If anabsolute difference function is used in process action 504, then therelative value of the secondary minimum provides a measure of howrepetitive the signal is. If the value of the secondary minimum meets adefined threshold range (508), then the degree of match indicates thatthe signal is repetitive, and the secondary minimum location provides anestimate of the signal period.

If the correlation value of the secondary peak or secondary minimum doesnot meet the defined threshold range, then a deviation from the regularphysiological activity is detected, thereby indicating an irregularityin the regular physiological movement of the patient (510). Thisirregularity could result, for example, from sudden movement or coughingof the patient. In an embodiment, this detected irregularity results inthe generation of a “beam hold” signal that suspends the application ofradiation at the patient.

If the degree of match indicates repetitiveness, the point of best matchis tested to determine if the period is within a reasonable range. Thelocation of the secondary peak or secondary minimum provides an estimateof the period of the physiological activity. In an embodiment, the pointof best match is compared to a threshold range (509). If the point ofbest match does not fall within the threshold range, than a deviationfrom regular physiological activity is detected (510). If the point ofbest match falls within the threshold range, then the signal is acceptedas being repetitive (512).

The estimate of the period based on the point of best match can be usedto predict the period and waveform parameters of the next set of datasamples for the signal (514). Note that process actions 504, 508, and509 test for repetitiveness based upon a plurality of data samples overa range of such samples. However, in some circumstances, a significantdeviation from normal physiological movement may actually occur withinthe new or most recent data sample(s) being analyzed, but because theoverall set of data samples indicates repetitiveness (e.g., because ofaveraging of absolute differences over the range of data samples beingcompared), process actions 504, 508, and 509 may not detect thedeviation. To perform a test for rapid deviation, the predicted valuefrom process action 514 is compared with the next corresponding datasample (515). If the predicted value does not match the actual datasample value within a defined threshold range, then deviation isdetected (510). If a comparison of the predicted and actual data samplevalues fall within the defined threshold range, then repetitiveness isconfirmed, and deviation is not detected for that data sample range(516).

In an embodiment, the first time the process of FIG. 5 is performed, thepattern matching process action (504) is performed over the entire rangeof data samples. Thereafter, the pattern matching process action can beperformed over a limited search interval, which is defined by theresults of the prior immediate execution of the process. For example,the predicted value from process action 514 can be used to define thelocation of the search interval for the next set of data samples.However, if process action 508, 509, and 514 detect deviation based uponanalysis of the initial search interval, then the search interval can beexpanded to ensure that a deviation has actually occurred. The processof FIG. 5 can be repeated with the increased search interval to attemptto find a point of best match outside of the initial search interval. Inan embodiment, this increased search interval comprises the entire rangeof data samples. Alternatively, the increased search interval comprisesonly an expanded portion of the entire range of data samples.

According to an embodiment of the invention, physiological gating can beperformed based upon the phase of the physiological activity, ratherthan its amplitude. This is in contrast to the example shown in FIG. 3,in which the amplitude of the physiological movement signal defines theboundaries of the treatment intervals for the application of radiation.

Referring to FIG. 9, depicted is an example of a chart 900 showing thephase progression of a physiological movement signal. Treatment intervalrange 902 has been defined over the phase chart 900. In the example ofFIG. 9, the boundaries of the treatment interval range 902 are definedby the phase of the detected signal. Radiation is applied to the patientonly when the phase of the physiological movement signal falls withinthe boundaries of the treatment interval range 902. FIG. 9 depictsexamples of treatment interval range 902 having boundaries that spanfrom 30 degrees to 300 degrees. Thus, the applied radiation to thepatient is suspended or stopped when the phase of the physiologicalmovement signal is between 301 degrees to 29 degrees.

Shown in FIG. 9 is a gating signal chart 906 that is aligned with phasechart 900. A “beam hold” signal threshold 910 results if the phase ofthe physiological movement signal falls outside the treatment intervalrange 902. A “beam on” signal threshold 912 results if the phase of thephysiological movement signal falls within the boundaries of thetreatment interval range 902. The “beam on” and “beam hold” signalthresholds 910 and 912 are applied to a switch 116 that operativelycontrols the operation of a radiation beam source 102 (FIG. 1). Ifradiation is being applied to the patient, application of the “beamhold” signal threshold 910 triggers switch 116 to suspend or stop theapplication of radiation. If radiation to the patient is not beingapplied, application of the “beam on” signal threshold 912 triggers theapplication of radiation to the patient.

The predictive qualities of the present invention permits operation of agating system even if the measured physiological movement involvesmotion that that is relatively fast when compared to the effectivelyoperating speeds of gating system components. As just one example,consider a gating system that includes a switch for gating the radiationtreatment, in which the switch requires a known time period Δt to fullyengage. If the switching time period Δt is relatively slow compared tothe measured physiological motion cycle, then a system employing such aswitch in a reactive manner may not be able to effectively gate theapplication of radiation at the patient.

The present invention allows predictive triggering of switch 116 tocompensate for the amount of time Δt required to fully engage theswitch. A predicted period for a physiological activity can be obtainedby employing the process of FIG. 5. A treatment interval range isdefined over a portion of the period of the physiological activity.Based upon the time Δt required to fully actuate the switch 116, theswitch 116 can be pre-actuated by this time period Δt prior to the timeof the boundary of the treatment interval, so that the time for fullactuation of the switch 116 coincides with the boundary of the treatmentinterval. Thus, the radiation can be effectively gated at the boundariesof the treatment interval, regardless of the operating speeds of theswitch 116. The same procedure can also be employed to compensate forthe operating speeds of other gating system components.

The following is an embodiment of the invention coded in the VisualBasic programming language. The following program code is directed to aprocess for detecting and predictively estimating the respiration cycleperiod using the absolute difference function: Public FunctionPredict(ByVal i As Long, ByVal Range As Long, Period As Double,MinAbsDiff As Double, Diff As Double) As Double Dim j As Long, StartJ AsLong, CurrJ As Long Dim k As Long, MaxK As Long Dim AbsDiff As DoubleDim NormAbsDiff As Double, n As Long k = Period − Range MinAbsDiff =10000000# StartJ = TimeRefldxBuf((i − 201 + BufLength) Mod BufLength)CurrJ = TimeRefldxBuf((i − 1 + BufLength) Mod BufLength) Do  j = StartJ AbsDiff = 0#  n = 0  Do  AbsDiff = AbsDiff +Abs(SigBuf(SigRefldxBuf(j)) −  SigBuf(SigRefldxBuf((j + k +  ChartWidth)Mod ChartWidth)))  n = n + 1  j = (j + 10) Mod ChartWidth  Loop.While n<= (200 − k)/10  NormAbsDiff = 100 * AbsDiff/  (n * Abs(MaxSignal −MinSignal))  If NormAbsDiff <= MinAbsDiff Then  MinAbsDiff = NormAbsDiff Max K = k  End If  k = k + 1 Loop While k <= Period + Range If MaxK >=40 And MaxK <= 150 Then Period = MaxK Predict =SigBuf(SigRefldxBuf((CurrJ − Period + ChartWidth) Mod ChartWidth)) Diff= 100 * Abs(SigBuf(SigRefldxBuf(CurrJ)) − Predict) / Abs(MaxSignal −MinSignal) If MinAbsDiff <= 20 Then  ProgressBar1.Value = MinAbsDiffElse  ProgressBar1.Value = 20 End If End Function

In this program code, the variable “i” represents a counter or index tothe data sample being processed. The variable “Range” represents thesearch range that is to be analyzed. If the period of the physiologicalcycle has already been determined (i.e., from a prior execution of thisprogram code), then the variable “Period” comprises the detected period.If the period has not yet been determined, then the variable “Period” isset to a default value representative of a normal respiration cycle(e.g., the number of data points in a normal breathing cycle, which isapproximately 95 data samples in an embodiment of the invention whereapproximately 200-210 data samples are obtained over an approximately 7second time period). The variable “MinAbsDiff” is the minimum absolutedifference value over the search range. The variable “Diff” represents acomparison between the actual value of a next data sample and theexpected value of that next data sample.

The variables “j”, “StartJ”, and “CurrJ” are counters or indexes intothe data samples being processed. The variable “k” is a counter to thesearch range. The variable “MaxK” represents the position in the searchrange having the minimum absolute difference value. The variable“AbsDiff” maintains the sum of the absolute difference values foroverlapping data samples. The variable “NormaAbsDiff” is the averageabsolute difference value for a particular position in the search range,which is represented as a percentage value. The variable “n” is used totrack the position of the data samples relative to the search range,which is represented as a percentage value. “Predict” is the predictedvalue that is returned by this program code.

The variable “MinAbsDiff” is initialized to a high value so that so thatany subsequent absolute difference value will be smaller than theinitialized value. In an embodiment, the set of data samples beingprocessed comprises 200 data points. Thus, in this program code, thevariable “StartJ” is initialized back 201 data samples. The variable“CurrJ” is initialized back one data sample. Because a circular array isbeing used, the “BufLength” variable is referenced during theinitialization of both “StartJ” and “CurrJ”.

The outer Do loop moves the current and preceding sets of data samplesrelative to each other. The outer Do loop is active while the variable“k” indicates that the program code is processing within the searchrange. In an embodiment, the search range is initially set at threepositions to either side of a predicted position. The predicted positionis based upon the period obtained for an immediately prior execution ofthe program code. If the program code has not been executed immediatelyprior, then a default period value is used. If an acceptable minimumabsolute difference value is not found within this search range, thenthe search range can be expanded to, for example, 50 positions to eitherside of the predicted position.

The variable “j” is initialized to the “StartJ” value. The variables“AbsDiff” and “n” are also initialized prior to execution of the innerDo loop.

The inner Do loop performs the computation of the absolute differencevalues between the present set and prior set of data samples. Thevariable “AbsDiff” maintains the sum of the absolute difference ofvalues for overlapping data samples being compared. Note that the numberof data samples being analyzed to determine the absolute differencevalues varies based upon the position in the search range beingprocessed. This results because different positions in the search rangehave different numbers of data samples that overlap with the previousset of data samples being compared. In the embodiment of this programcode, the absolute difference function is computed using every 10^(th)signal sample point, i.e., a subsampled subtraction is used. Because acircular array is being used, the “Chartwidth” variable is referencedduring the calculation of “AbsDiff”.

The variables “MaxSignal” and “MinSignal” indicate a maximum and minimumrange for signal values that have previously been sampled. These valuescan be established, for example, during a learning period for the systemin which data samples are obtained for a plurality of respiratorycycles. The “NormAbsDiff” variable holds the average absolute differencevalue represented as a percentage value based upon the “MaxSignal” and“MinSignal” values.

If the “NormAbsDiff” value is less than or equal to a previouslyestablished “MinAbsDiff” value, then the “MinAbsDiff” variable is set tothe “NormAbsDiff” value. The “MaxK” variable is set to the value of “k”if the “MinAbsDiff” value is reset. The variable “k” is thenincremented, and if the “k” value is still within the search range, thenthe program code returns back to the beginning of the outer Do loop.

The result of this program code is a candidate minimum absolutedifference value and a candidate position for the minimum absolutedifference. The MaxK value is compared to pre-defined threshold valuesto ensure that it falls within a correct range of values for thephysiological activity being processed. Thus, in an embodiment, the MaxKvalue is tested to make sure that it is greater than or equal to 40 andless than or equal to 150. If the mark value meets the threshold range,then the variable “Period” is set to the “MaxK” value. The variable“Predict” returns the predicted value for the next set of data samplesto be processed. The variable “Diff” indicates the difference valuebetween the current data sample value and the predicted data samplevalue, and is represented as a percentage to the “MaxSignal” and“MixSignal” values.

In an embodiment, an image of a progress bar can be displayed tovisually indicate the periodicity of the signal samples. According tothe program code, if the “MinAbsDiff” value is less than or equal to a20% difference, then the visual progress bar is updated with thecomputed “MinAbsDiff” value. Otherwise, the visual progress bar displaysall other “MinAbsDiff” values that exceed a 20% difference as a defaultvalue of “20”.

FIG. 13 a shows a flowchart of an alternative approach for detectingdeviation from periodicity of a physiological activity. For the purposesof illustration only, and not to limit the scope of the invention, thepresent explanation is made with respect to the periodicity ofrespiration activity. This process tracks the phase of a periodicsignal, and for each breathing signal sample, this approach provides anestimate of phase value indicating the breathing cycle phase for thepatient. In the embodiment described here, the phase angles ranges from0 to 2π (0 to 360 degrees) with 0 and 2π corresponding to the vicinityof inhale extreme of the respiration signal. FIG. 13 c shows an examplephase value chart 1350 for breathing signal samples superimposed on anexample respiration amplitude signal 1352.

The process of FIG. 13 a receives a respiration data sample at step1302. For each new sample of the respiration signal, the process obtainsand updates estimates of the latest inhale and latest exhale extremevalues and corresponding time points of the respiration signal. Thesevalues are used to establish the latest estimates of exhale period,inhale period, and therefore T, the overall period of breathing (1304).

At step 1306, the process estimates the phase value of the newlyacquired respiration signal sample. In an embodiment, this is performedby computing the inner product of a Cosine waveform with period T(estimated at step 1304) and the most recent T-seconds-long segment ofthe signal. This is repeated by computing the inner product with a Sinewaveform of period T. These two inner products are called, respectively,the in-phase and quadrature components of the signal. The inverseTangent of the result of dividing the quadrature value by the in-phasevalue provides the estimated phase for the current respiration signalsample.

At step 1308, the process compares the vector, e.g., (amplitude, phase),of the current respiration sample with previous data sample values todetermine periodicity of the signal. One approach to performing thiscomparison step is to use a two-dimensional histogram array of signalvs. phase value that is accumulated during prior recordings of therespiration signal. FIG. 13 d shows an embodiment of a 2-dimensionalhistogram array 1360 of amplitude-phase values. Histogram array 1360 isa 64×64 array of bins covering the 0 to 2π phase in the horizontaldimension and the range of respiration signal amplitude in the verticaldimension. The amplitude and estimated phase of each new sample are usedto increment the corresponding bin in histogram array 1360.

In an embodiment, a clustering factor determines how close the currentrespiration data sample vector is to the cluster of values observed sofar. By comparing the amplitude-phase vector of each signal sample withthe cluster of prior values in its neighborhood, the process provides ameasure of periodicity for the signal. The signal is considered periodicfor the current sample time when the clustering factor is above adefined threshold or tolerance level (1314). Otherwise the signal isdeclared non-periodic (1312). One approach is to calculate the sum ofthe bin populations for the 8-amplitude×5-phase surrounding bins for thecurrent data sample. This population, as a percentage of the totalpopulation of all histogram bins accumulated so far, determines thedegree to which the new sample belongs to a periodic signal. By applyinga threshold to this percentage value, the signal sample is declared asperiodic or non-periodic. This threshold value can be set by the user asthe sensitivity of the algorithm for detecting deviations fromperiodicity. In the example of FIG. 13 d, data sample set 1362 wouldpresumably be declared as non-periodic since it substantially deviatesfrom the general body of data sample values 1364, assuming that thevalues in data sample set 1362 cause the determined percentage value toexceed a defined threshold.

According to an embodiment, estimation of the inhale and exhale periodspursuant to step 1304 of FIG. 13 a begins by identifying a startingassumption of these periods. If the process is at its very beginning, oris recovering from a loss of periodicity, then nominal or default values(such as inhale period=1.6 Sec and exhale period 3.4 Sec) are used. Thesum of these values is the current estimate of the physiologicalmovement period. The approach of the present embodiment uses the mostrecent n samples of the signal to estimate the location and value of theminimum and maximum values, e.g., caused by breathing motion. Oneembodiment selects seven samples by sub-sampling the signal at intervalsof 1/20^(th) of the period. The choice of seven samples makes thecomputational load of the interpolation process manageable, whilesub-sampling allows coverage of a larger portion of the signal thusavoiding false detection of local minima and maxima due to noise. Forevery new sensed signal sample (not sub-sampled) the n samples selectedas described above are first validated to make sure their correspondinginterval includes a minimum or a maximum. This is performed by comparingthe absolute difference of the two end samples of the sample train withthe average of the difference of the center sample and the two endsamples. One embodiment uses the test:Abs(Y(0)−Y(6))<0.2*Abs(Y(0)+Y(6)−2*Y(3))to determine whether the sample train includes a minimum or a maximum.In this example the train of seven samples, Y(0), Y(1), Y(2), Y(3),Y(4), Y(5), Y(6), are sub-sampled at 1/20^(th) of the of the number ofsamples constituting the current estimate of one period. If the resultof this test is positive, curve fitting to the samples is performed. Oneembodiment fits a quadratic curve to the middle five points of theseven-point sample train. The location and value of the minimum ormaximum value of this curve is computed using interpolation. Also atthis point, it is determined whether the estimated point is a minimum ora maximum by comparing the end samples of the train with the middlesample. The estimated location of the minimum or maximum points areadded to their respective accumulator variables for later averaging.

The above process is repeated with the next sensed signal sample untilthe procedure encounters the first sample for which the above testresult is negative. This is an indication that the run of points forwhich a minimum or maximum can be estimated has ended. At this point theaccumulator variables are divided by the number of points in the run toobtain the average location and value from the run.

The process continues by repeating the above test on the sample-trainpreceding every new sensed signal sample. Once the test result ispositive the averaging process described above will start again. FIG. 13b shows three examples of sample trains; sample train 1360 includes alocal maximum; sample train 1362 includes a local minimum; and, sampletrain 1364 includes neither a maximum nor a minimum.

This method estimates the local minimum or maximum location at a pointin time that is later than the actual position of the extremum by thelength of the sample train. The current estimate of the inhale or exhaleperiod is updated at this point in time. For inhale period, for example,this is performed by subtracting the latest maximum position from thelatest minimum position in time. These estimates are used to update thecurrent value of the total period.

The embodiments described herein provides a tool for measuring theperiodicity of the respiration signal, thus allowing detection ofdeviation from normal physiological movement, e.g., deviation fromnormal breathing caused by a patient coughing or moving. This can beused during therapy, imaging, and interventional procedures that isfacilitated or require monitoring of normal patient movement. Inaddition, the knowledge of the phase of the physiological activityallows predictive or prospective triggering of image acquisition or theonset of radiation therapy beam in situations where these systemsrespond after a known delay.

Planning Phase and Interface

During the planning phase of the radiation treatment, gating simulationscan be performed to determine the optimum boundaries of the treatmentintervals. FIG. 12 a depicts a system 1200 that can be employed toperform gating simulation. As with the system 100 shown in FIG. 1,system 1200 comprises a camera 108 that is directed at a patient on atreatment table 104. The output signals of camera 108 are sent to acomputer 110 for processing. System 1200 additionally includes animaging system capable of generating images of internal structureswithin the patient's body. In an embodiment, system 1200 comprises adigital fluoroscopic imaging system having an x-ray source 1202 andfluoroscopic x-ray detection apparatus 1204. The resulting fluoro videocan be displayed on a fluoro display device 1206. In addition, theoutput signals from the fluoroscopic x-ray detection apparatus 1204 canbe sent to the computer 110.

During gating simulation, the movement of one or more landmarks ormarkers 114 on the patient's body is optically measured using camera108. The detected motion of the landmark or marker 114 results in thegeneration of motion signals according to the process discussed withreference to FIG. 2. While motion data is being collected, thefluoroscopic video system generates imaging data for the tumor or tissuethat is targeted for irradiation. The present invention records thefluoroscopic image data and the marker motion data simultaneously on acommon time base. In an embodiment, the positional geometry of thefluoroscopic imaging system is configured to correspond to theprojection geometry of the radiation beam source that will be used inapplying radiation beams for treatment. This allows accurate simulationof the target volume to be achieved during actual treatment.

FIG. 12 b depicts an embodiment of a user interface 1210 for presentingthe recorded data of the fluoro images and motion signals. A portion ofuser interface 1210 displays a chart 1212 of the measured motionsignals. Another portion of user interface 1210 displays internal imagedata, e.g., fluoro video 1214. During the planning phase of treatment,the fluoro video 1214 of the targeted body part or location, e.g., atumor or in cases where the tumor is not visible in fluoroscope imageanother anatomical landmark whose motion is highly correlated with thetumor, can be displayed in synchronization with the display of themotion signals. Simultaneous display of both sets of data allow a visualmanner of determining the proper boundaries of the treatment intervals,based upon the range of movements of the targeted body part, location,tissue or tumor during particular portions of the motion signals.

Gating simulations can be effected by performing “gated playback.” Gatedplayback involves setting simulated threshold boundaries for thetreatment intervals. During the gated playback, the user interface canbe configured to only display the fluoro image when the motion signal iswithin the boundaries of the simulated treatment intervals. The fluorovideo can be turned off or frozen if the motion signal is outside thesimulated treatment intervals. The gating threshold can be dynamicallyadjusted while both the fluoro video and the motion signals aredisplayed in the user interface. The playback/adjustment procedure canbe performed until the physician is satisfied with the gating thresholdsof the treatment window. The display rate can be dynamically adjusted tospeed or slow down the visual playback of the fluoro video.

In an embodiment, a visual display border can be formed around region(s)of interest in the fluoro video 1214. For example, a box-like displayborder can be drawn around a tumor shown in fluoro video 1214.Alternatively, a display border generally matching the shape of a tumorcan be drawn around that tumor. The visual display border can be used tosimulate the shape of an applied radiation beam. During playback, themovement of the tumor in relation to the visual display border atparticular points in the motion signal range can help determine theproper boundaries of the treatment intervals.

The recorded fluoro image allows digital analysis and quantification ofthe amount of tumor motion resulting from regular physiologicalmovement. For each image frame, the image data corresponding to thetumor or targeted tissue can be highlighted or otherwise selected by thecomputer 110. Calculations can be performed upon this image data toanalyze motion of the tumor or tissue during the regular physiologicalmovements.

According to an embodiment, this analysis can be performed by edgedetection and tracking. This applies to anatomic landmarks, such as thediaphragm supporting the lungs, which show an intensity edge in thefluoroscope images. The user designates an edge in a frame of therecorded fluoro segment. This could be done by drawing a line segment ator near the edge. Then, edge detection and localization is performed todetermine the exact position of the edge to be found. The movie is thenstepped to the next frame. In this new frame the position of the linesegment corresponding to the edge location in the previous frame is usedto find the edge again. This process is continued for the length of therecorded fluoro segment. The edge position, and its rate of change, isused to select the optimum treatment interval.

According to another embodiment, an area of the fluoroscope image istracked from frame to frame using template matching. A template isselected in the first frame by drawing a box around the area of tumor oranother landmark whose motion is correlated with tumor. This area underthe box is used as a template that searched for in the next frame of thevideo segment. Since the extent of motion is limited at typical framerates of 10 or higher frames per second, the search area for templatematching will also be limited. One embodiment of template matching usestwo-dimensional cross correlation in which the position of thecorrelation peak is used to find the position of the template in the newimage frame. Another embodiment uses minimum absolute difference of thetemplate and candidate templates in the new image. Using the absolutedifference approach, the position of the minimum absolute differencewill indicate the position of the template in the new frame. For bothcross-correlation and minimum absolute difference embodiments, oncematching template is found in the new frame, it is used as the templateto be searched for in the subsequent image frame of the recoded video.The two-dimensional trajectory of the template position found in thisway is then analyzed in order to determine optimum treatment intervalsthat correspond to least motion of specific range of positions of thetracked template.

The quantified movement data of the targeted body part, location, tumor,or tissue allows precise determination of gating thresholds for thetreatment intervals. For example, if the physician desires the treatmentintervals to include periods of movements that will not exceed a certainthreshold movement margin, then the quantified movement data can beanalyzed to determine the exact boundaries of the treatment intervalsthat achieves the desired movement margin. Alternatively, certain presetmovement margin thresholds can be programmed into the computer 110.Based upon the preset movement margins, the system can perform ananalysis of the movement data to determine the optimal gating thresholdsof the treatment intervals to achieve the preset movement margins. Thisgating threshold can be designated as the default or suggested treatmentintervals for the corresponding patient.

Verification can be performed to validate the gating threshold settingsof the treatment intervals. This is particularly useful during deliveryof fractionated treatment.

This can be done by gated verification imaging performed during atreatment session with the radiation beam source. Gated electronicportal images can be obtained during delivery of the fractionatedradiation treatments. To accomplish this, the gating system triggers asingle exposure or a sequence of exposures which can be visually orautomatically compared to the original reference images. Theverification can be repeated at any point deemed clinically appropriateduring the treatment schedule.

Patient Positioning

The position and motion monitoring system 100 can also be used toposition the patient accurately in imaging and therapy applicationsinvolving multiple patient visits to a medical device, system, or room.During patient setup, the position and orientation of the marker blockis recorded. By placing a marker block at the same position on thepatient skin in each session, its 3-dimensional position in room ormachine isocenter coordinates is an accurate representation of thepatient position. At a subsequent session, the position of the patientis adjusted until the marker block is consistent with the recordedposition and orientation.

FIG. 18 illustrates how the invention can be used to position a patient106 among multiple medical devices. For the purposes of illustration,consider a common scenario for performing radiation therapy. A firstphase of radiation therapy is a setup or treatment planning operationthat consists of performing scanning or imaging procedures upon thepatient to accurately locate and define the area of the patient body tobe treated, e.g., using CT, MRI, SPECT, or PET procedures. The imagedata is used to develop a radiation treatment plan. The treatment planoften comprises the dosage level and treatment volume of radiotherapy toapply to the patient. The treatment planning phase may also comprise asimulation procedure to verify the appropriateness of the treatmentplan. Once the treatment plan is developed, the second phase involvesmoving the patient to a radiation therapy device to implement thetreatment plan. To optimize this procedure, the patient's relativeposition to the radiation therapy device should be consistent relativeto the patient's imaging position for the image data used to develop thetreatment plan.

According to an embodiment of the invention, the optical position andmotion monitoring system of the present invention is usable toaccurately and consistently position a patient among multiple medicaldevices. Shown in FIG. 18 is a patient 106 co-located with a markerblock 114. During setup operations, the patient is scanned or imagedusing an imaging device, such as MRI device 1802 or a CT system. Duringpatient setup, a first video camera 108 a provides images of the patientto record the position and orientation of the marker block 114. The3-dimensional position or machine isocenter coordinates of the markerblock 114 for the imaging session at the MRI device 1802 is stored asreference data.

During the subsequent treatment session, the patient 106 is moved to aradiation therapy device 1804. In an embodiment, the treatment table 104upon which the patient 106 is resting is configured such that it can bemoved between the MRI device 1802 and the radiation therapy device 1804.This can be accomplished, for example, by movably attaching thetreatment table 104 to floor rails 1806. Moving the entire treatmenttable 104 to move the patient 106 between medical devices, rather thanmoving just the patient 106, reduces the chance that internal organswithin the patient will shift during movement.

Because the geometry of the first camera 108 a to the MRI device 1802 isknown, and the geometry of the second video camera 108 b to theradiation therapy device 1804 is also known, it is possible to translatethe relative position of the patient during the imaging session beforethe MRI device 1802 into a corresponding relative position at theradiation therapy device 1804. This corresponding relative position isthe desired position at the radiation therapy device 1804 to maximizethe efficacy of the treatment plan developed based upon imaging geometryat the MRI device 1802.

When the treatment table 104 is moved to the radiation therapy device1804, a second video camera 108 b provides images of the patient 106that is used to calculate the 3-dimensional position or machineisocenter coordinates of the marker block 114. Because the desiredpatient/marker block location is known, the patient 106 or treatmenttable 104 can be shifted until the marker block is consistent withdesired position and orientation.

During patient positioning, the therapist can monitor patient positionin real time using indicators such as the slider interface 1600 shown inFIG. 16. Each slider in interface 1600 shows position in a specificdimension relative to the reference session. The slider element 1610 inslider 1602 tracks motion of the patient in theanterior/posterior-posterior/anterior dimension. Slider 1604 tracks thelateral movement of the patient. Slider 1606 tracks theSuperior-Inferior movement of the patient. The exact positions of sliderelements in interface 1600 are recorded during patient setup. To performpatient positioning, the position of the patient is adjusted until theslider bars are consistent with the measured positions of the sliderelements from the setup phase. When a patient is surveyed during setup,the slider positions representing the patient coordinates are recorded.Each slider can be configured to show the expected range of respirationmotion as a reference interval, which is shown in interface 1600 as ablack bar within each slider 1602, 1604, and 1606. For example, blackbar 1608 shows the normal expected range of motion for the sliderelement 1610 in slider 1602.

Patient Feedback and Breath Hold

According to an embodiment of the invention, a real time positionindicator display is provided that can also serve as patient visualfeedback for both regulating and limiting the breathing motion in normalbreathing mode. The position indicator display is also usable forpositive cooperation by patient in breath-hold mode of imaging andinterventional procedures.

Medical procedures in which a patient may be instructed to hold breathinclude image acquisition procedures and interventional procedures suchas biopsy needle insertion. Typically, several breath holds separated bynormal patient breathing are usually required to complete the imageacquisition or delivery of radiation dose for therapy. In conventionalbreath hold applications, it is extremely difficult for a patient tomaintain a consistent position from one breath hold to another breathhold. This difficulty arises because the patient cannot preciselydetermine the exact point to consistently hold breath from one instanceto another. Thus, it is possible that the volume or position of apatient's chest/abdomen differs from one breath hold to another.

As noted above, the optical monitoring system of FIG. 1 can be used toquantify the position and orientation of a patient positioncorresponding to a marker block or a set of markers. Thus, the positionand offset of movement by a patient during breath hold can bequantified. By quantifying these values during breath hold, the patientposition during breath hold can be reliably and consistently repeated.

FIG. 17 shows one embodiment of a real time position indicator 1700using a slider that is displayed to the patient on a computer display.The slider position 1702 shows, for example, the up-down chest positionfor a horizontal patient setup. During exhale, the slider position 1702moves up and during inhale, the slider position 1702 moves down. Theexpected range of positions, e.g., for breath holding is shown as aninterval 1704.

The patient is instructed to try and maintain the position of the sliderbar 1702 within the boundaries of the indicated range 1704, where theposition and width of this range of motion is selected according to whatthe patient could comfortably achieve in the planning session. In anembodiment, the visual feedback tool is also used to encourage thepatient to breathe more shallowly than he or she normally would. Verbalprompting and feedback can also be provided to the patient to influencea more consistent physiological pattern. For example, an audio message“breathe in” can be performed to prompt a patient during a desiredinhale period. An audio message “breathe out” can be performed to prompta patient during a desired exhale period. An audio message “hold breath”can be performed to prompt a patient during a desired breath holdperiod.

The interface of FIG. 16 can also be used to graphically quantify thepatient breath hold position. An indicator range can be placed in one ormore of the sliders in interface 1600 at a desired breath hold position.To recreate that breath hold position, the patient is instructed to holdbreath until the slider bars within the appropriate sliders correspondto the marker position on the sliders. For imaging applications, theonset of image acquisition for each breath hold is triggered when markerblock position enters the range corresponding to breath-hold, and isautomatically stopped when the patient relaxes and marker block exitsthe breath hold range. This makes the breath hold imaging mode moreaccurate and robust because without such position monitoring capabilitythe patient breath hold position can change from breath-hold tobreath-hold.

Interface Controls

FIG. 20 displays an indicator display 2000 for controlling anddisplaying motion and gating information. Display 2000 comprises agraphical signal chart 2002 that tracks the physiological movement ofthe patient, e.g., by tracking the motion of a marker block. A phasedisplay portion 2004 includes a moving display bar 2006 that tracks thephase of the physiological movement. If gating based upon phase isemployed, then the gating range or non-gating range can be controlled bydefining a treatment window 2008 in the phase display portion 2004. Thetreatment window 2008 is defined to extend from a first phase value to asecond phase value within the phase display portion 2004. Alternatively,gating can be implemented by defining treatment intervals 2010 over theamplitude signal chart 2002 of the physiological movement.

To provide visual prompting for a patient, a desired movement window2012 is displayed over the signal chart 2002. During the exhale period,the patient is instructed to try and maintain the position of the signalchart 2002 within the lower boundaries of the indicated range for themovement window 2012. During the inhale period, the patient isinstructed to try and maintain the position of the signal chart 2002within the upper boundaries of the movement window 2012.

FIG. 21 shows an interface window for controlling a CT gating andmonitoring system. A control portion 2102 is used to turn on or off CTgating. The control portion 2106 sets a threshold value for determiningdeviation from periodicity of the breathing cycle, e.g., as used for theprocess of FIG. 13 a. The control portion 2108 determines whether gatingis performed based upon either amplitude or phase. The control portion2104 allows entry of the known or estimated CT scanner delay and scanlength parameters for the CT scanners that do not have a feedbackinterface for automatic sensing of these parameters. These parametersare used to show the best estimate of the CT scan period on thebreathing chart. In an embodiment of the invention the portion ofbreathing chart corresponding to the CT scan period is drawn in colorgreen. For example in a therapy application this allows selection ofgating thresholds that result in the best match of the beam-on periodand the CT image acquisition interval, i.e., the user tries to match thebeam-on period with the green portions of the breathing chart.

FIG. 22 shows an interface window for controlling patient prompting andfeedback. Control portion 2202 determines whether audio prompting isperformed to regulate the physiological movement. Control portion 2204determines whether the inhale and exhale periods for patient feedback ismanually or automatically set. If the inhale and exhale periods aremanually set, then the inhale/exhale period values shown in controlportion 2206 are manually configured. If the inhale and exhale periodsare automatically set, then these periods are automatically determined,e.g., using the process shown in FIG. 13 b. In this case the controlportion 2206 is used to increment or decrement the automatically sensedinhale and exhale periods before using them to prompt the patient. This,for example, is used to encourage the patient to breathe more slowlythan he or she would normally breath.

FIG. 23 shows an interface window for controlling the visual feedbackused to limit the motion range for the physiological movement. A controlportion 2302 determines whether the motion range is manually orautomatically set. If the motion range is manually set, then the motionrange value shown in control portion 2304 is manually configured.Otherwise, the control portion 2304 is automatically configured, e.g.,based upon the sensed motion range for the marker block.

FIG. 24 shows a screenshot of a display window according to anembodiment of the invention. A first portion of the display window showsthe sliders of FIG. 16 quantifying real-time motion of the marker block.A second portion of the display window shows the control interface ofFIG. 20. A third portion of the display window shows a real-time imageof the patient as seen through the video camera.

Computer System Architecture

FIG. 12 is a block diagram that illustrates an embodiment of a computersystem 1900 upon which an embodiment of the invention may beimplemented. Computer system 1900 includes a bus 1902 or othercommunication mechanism for communicating information, and a processor1904 coupled with bus 1902 for processing information.

Computer system 1900 also includes a main memory 1906, such as a randomaccess memory (RAM) or other dynamic storage device, coupled to bus 1902for storing information and instructions to be executed by processor1904. Main memory 1906 also may be used for storing temporary variablesor other intermediate information during execution of instructions to beexecuted by processor 1904. Computer system 1900 further includes a readonly memory (ROM) 1908 or other static storage device coupled to bus1902 for storing static information and instructions for processor 1904.A data storage device 1910, such as a magnetic disk or optical disk, isprovided and coupled to bus 1902 for storing information andinstructions.

Computer system 1900 may be coupled via bus 1902 to a display 1912, suchas a cathode ray tube (CRT), for displaying information to a user. Aninput device 1914, including alphanumeric and other keys, is coupled tobus 1902 for communicating information and command selections toprocessor 1904. Another type of user input device is cursor control1916, such as a mouse, a trackball, or cursor direction keys forcommunicating direction information and command selections to processor1904 and for controlling cursor movement on display 1912. This inputdevice typically has two degrees of freedom in two axes, a first axis(e.g., x) and a second axis (e.g., y), that allows the device to specifypositions in a plane.

The invention is related to the use of computer system 1900 fordetecting and predictively estimating physiological cycles. According toone embodiment of the invention, such use is provided by computer system1900 in response to processor 1904 executing one or more sequences ofone or more instructions contained in main memory 1906. Suchinstructions may be read into main memory 1906 from anothercomputer-readable medium, such as storage device 1910. Execution of thesequences of instructions contained in main memory 1906 causes processor1904 to perform the process steps described herein. One or moreprocessors in a multi-processing arrangement may also be employed toexecute the sequences of instructions contained in main memory 1906. Inalternative embodiments, hard-wired circuitry may be used in place of orin combination with software instructions to implement the invention.Thus, embodiments of the invention are not limited to any specificcombination of hardware circuitry and software.

The term “computer-readable medium” as used herein refers to any mediumthat participates in providing instructions to processor 1904 forexecution. Such a medium may take many forms, including but not limitedto, non-volatile media, volatile media, and transmission media.Non-volatile media includes, for example, optical or magnetic disks,such as storage device 1910. Volatile media includes dynamic memory,such as main memory 1906. Transmission media includes coaxial cables,copper wire and fiber optics, including the wires that comprise bus1902. Transmission media can also take the form of acoustic or lightwaves, such as those generated during radio wave and infrared datacommunications.

Common forms of computer-readable media include, for example, a floppydisk, a flexible disk, hard disk, magnetic tape, or any other magneticmedium, a CD-ROM, any other optical medium, punch cards, paper tape, anyother physical medium with patterns of holes, a RAM, a PROM, and EPROM,a FLASH-EPROM, any other memory chip or cartridge, a carrier wave asdescribed hereinafter, or any other medium from which a computer canread.

Various forms of computer readable media may be involved in carrying oneor more sequences of one or more instructions to processor 1904 forexecution. For example, the instructions may initially be carried on amagnetic disk of a remote computer. The remote computer can load theinstructions into its dynamic memory and send the instructions over atelephone line using a modem. A modem local to computer system 1900 canreceive the data on the telephone line and use an infrared transmitterto convert the data to an infrared signal. An infrared detector coupledto bus 1902 can receive the data carried in the infrared signal andplace the data on bus 1902. Bus 1902 carries the data to main memory1906, from which processor 1904 retrieves and executes the instructions.The instructions received by main memory 1906 may optionally be storedon storage device 1910 either before or after execution by processor1904.

Computer system 1900 also includes a communication interface 1918coupled to bus 1902. Communication interface 1918 provides a two-waydata communication coupling to a network link 1920 that is connected toa local network 1922. For example, communication interface 1918 may bean integrated services digital network (ISDN) card or a modem to providea data communication connection to a corresponding type of telephoneline. As another example, communication interface 1918 may be a localarea network (LAN) card to provide a data communication connection to acompatible LAN. Wireless links may also be implemented. In any suchimplementation, communication interface 1918 sends and receiveselectrical, electromagnetic or optical signals that carry data streamsrepresenting various types of information.

Network link 1920 typically provides data communication through one ormore networks to other devices. For example, network link 1920 mayprovide a connection through local network 1922 to a host computer 1924or to medical equipment 1926 such as a radiation beam source or a switchoperatively coupled to a radiation beam source. The data streamstransported over network link 1920 can comprise electrical,electromagnetic or optical signals. The signals through the variousnetworks and the signals on network link 1920 and through communicationinterface 1918, which carry data to and from computer system 1900, areexemplary forms of carrier waves transporting the information. Computersystem 1900 can send messages and receive data, including program code,through the network(s), network link 1920 and communication interface1918.

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. Forexample, the operations performed by computer 110 can be performed byany combination of hardware and software within the scope of theinvention, and should not be limited to particular embodimentscomprising a particular definition of “computer”. The specification anddrawings are, accordingly, to be regarded in an illustrative rather thanrestrictive sense.

1-109. (canceled)
 110. A method for use with a radiation procedure,comprising: obtaining a first respiratory phase of a respiratory cycle;obtaining a second respiratory phase of the respiratory cycle; andgenerating a signal; wherein the signal has a start point thatcorresponds with the first respiratory phase, and an end point thatcorresponds with the second respiratory phase.
 111. The method of claim1, wherein the signal is configured to activate a radiation source for aduration between the first and the second respiratory phases.
 112. Themethod of claim 1, further comprising determining a duration based onthe first and the second respiratory phases.
 113. The method of claim 3,wherein the signal is configured to activate a radiation source for theduration.
 114. The method of claim 1, further comprising displaying agraph representing the respiratory cycle.
 115. The method of claim 1,further comprising displaying a signal chart representing the signal.116. The method of claim 1, further comprising: displaying a graphrepresenting the respiratory cycle; displaying a signal chartrepresenting the signal; wherein the signal chart is aligned with thegraph to a common time base.
 117. The method of claim 1, wherein thesignal comprises a “ON” signal.
 118. The method of claim 1, wherein thesignal comprises a “OFF” signal.
 119. A computer program productincludes a computer-readable medium, the computer-readable medium havinga set of stored instructions, an execution of which causes a process tobe performed, the process comprising: obtaining a first respiratoryphase of a respiratory cycle; obtaining a second respiratory phase ofthe respiratory cycle; and generating a signal; wherein the signal has astart point that corresponds with the first respiratory phase, and anend point that corresponds with the second respiratory phase.
 120. Asystem for use in a radiation procedure, comprising: means for obtaininga first respiratory phase of a respiratory cycle; means for obtaining asecond respiratory phase of the respiratory cycle; and means forgenerating a signal; wherein the signal has a start point thatcorresponds with the first respiratory phase, and an end point thatcorresponds with the second respiratory phase.
 121. A method for usewith a radiation procedure, comprising: obtaining a respiratory phase ofa respiratory cycle; obtaining a width; and generating a signal; whereinthe signal has a start point and an end point, the start pointcorresponding with the respiratory phase, and a duration between thestart point and the end point corresponding with a duration of thewidth.
 122. The method of claim 12, wherein the width is expressed intime.
 123. The method of claim 12, further comprising displaying a graphrepresenting the respiratory cycle.
 124. The method of claim 12, furthercomprising displaying a signal chart representing the signal.
 125. Themethod of claim 12, further comprising: displaying a graph representingthe respiratory cycle; displaying a signal chart representing thesignal; wherein the signal chart is aligned with the graph to a commontime base.
 126. The method of claim 12, wherein the signal comprises a“ON” signal.
 127. The method of claim 12, wherein the signal comprises a“OFF” signal.
 128. A computer program product includes acomputer-readable medium, the computer-readable medium having a set ofstored instructions, an execution of which causes a process to beperformed, the process comprising: obtaining a respiratory phase of arespiratory cycle; obtaining a width; and generating a signal; whereinthe signal has a start point that corresponds with the respiratoryphase, and is configured to activate a radiation source for a durationof the width.
 129. A system for use in a radiation procedure,comprising: means for obtaining a respiratory phase of a respiratorycycle; means for obtaining a width; and means for generating a signal;wherein the signal has a start point that corresponds with therespiratory phase, and is configured to activate a radiation source fora duration of the width.
 130. A method for use in a radiation procedure,comprising: collecting a first set of data representative of arespiratory motion of a patient; obtaining a second set of datarepresentative of a reference respiratory motion; performing an analysisusing the first and the second sets of data to determine whether therespiratory motion deviates from the reference respiratory motion; andgenerating a signal based at least on a result of the step ofperforming.
 131. The method of claim 21, wherein the performingcomprises comparing the first set of data with the second set of data.132. The method of claim 21, wherein the performing the analysiscomprises performing a pattern matching analysis.
 133. The method ofclaim 21, wherein the performing comprises determining a degree ofdeviation between the respiratory motion and the reference respiratorymotion.
 134. The method of claim 21, wherein the second data is a modelof a respiratory wave form.
 135. The method of claim 21, furthercomprising generating the second set of data.
 136. The method of claim26, wherein the second set of data is generated using respiratory motiondata of the patient.
 137. The method of claim 21, wherein the signal isa “ON” signal.
 138. the method of claim 21, wherein the signal is a“OFF” signal.
 139. A computer program product includes acomputer-readable medium, the computer-readable medium having a set ofstored instructions, an execution of which causes a process to beperformed, the process comprising: collecting a first set of datarepresentative of a respiratory motion of a patient; obtaining a secondset of data representative of a reference respiratory motion; performingan analysis using the first and the second sets of data to determinewhether the respiratory motion deviate from the reference respiratorymotion; and generating a signal based at least on a result of the stepof performing.
 140. A system for use in a radiation procedure,comprising: means for collecting a first set of data representative of arespiratory motion of a patient; means for obtaining a second set ofdata representative of a reference respiratory motion; means forperforming an analysis using the first and the second sets of data todetermine whether the respiratory motion deviate from the referencerespiratory motion; and means for generating a signal based at least ona result of the step of performing.